Psych Station 8

Setting:

You are the intern on call at a general hospital. The nurse on the psychiatric ward has called you about a 30-year-old male patient who is expressing acute agitation.

Name (patient): James Turner

Name (nurse) : Simon

Tasks:

1. Take a history from the nurse over the phone.

2. Discuss the intial management plan with the nurse.

You are not required to review the patient during this station.

Briefing

Diagnosis: Acute Agitation (in context of schizophrenia)
You are Simon, a nurse on a psychiatry ward looking after a patient named James Turner.
You have called the intern because your patient has become acutely aggresive to staff.

Appearance and Behaviour

Initially you are heightened because the patient just threatened your junior nursing staff and you want the doctor to come NOW to sort this out. You settle if the doctor is reassuring and apologise.

Opening statement

“Doctor you have to come to the psych ward now, James is getting aggresive and threatening staff!”

Presenting Complaint

Diagnosis - James has a diagnosis of Schizophrenia which is why he's on the psych ward
History - inpatient for 3 weeks and was initially doing well on medication
Timing - behaviour change started this morning and he's become increasingly agitated throughout the day
Behaviour - verbally aggressive to patients and staff, no physical violence, pacing angrily, threatening to leave the hospital, things are escalating
Abnormal thoughts - James is saying that the hospital staff are plotting against him and that the medications are "poison."
Medication - been refusing antipsychotics for 48 hours, he's still refusing oral medications
Vitals - normal vitals yesterday, he's now refusing vitals
Triggers - He had a phone call with his sister two days ago that seemed to upset him, but we don’t know the details of what was said.

Past Medical History

Previous similar episodes - has been settled until today
Other medical conditions - none

Drug History

Prescribed - Olanzapine 15mg nocte which he is refusing as it's “poison“
Prescribed - Lorazepam 1mg oral which has not been tried yet
Allergies - None

Systems Review

If asked about physical symptoms say you're not sure because James has been withdrawn and is refusing Obs.

Ideas / Concerns / Expectation

Concerns - We’re concerned that if he escalates, we might have to use physical restraint, which we want to avoid.
Expectations - I'd like you to review as soon as possible doctor.

Discussion / Questions

You should be responsive to reassurance.